There are three types of exemptions that an individual can possibly have access to in order to be waived from immunization laws; although federal public health officials at the Center for Disease Control (CDC) issue recommendations for immunization policy and procedure, there is no federal law governing immunization and thus the access to one of these exemptions varies state by state. Additionally, the filing of a personal exemption is regulated differently in each state.

The three types of exemptions are: medical, religious, or personal beliefs. Currently all 50 states allow for medical exemptions, 48 allow for religious exemptions, and 17 allow for philosophical/personal belief exemptions. If California passes SB277, it will be only the third state to disallow religious exemptions from vaccination requirements by law.

Medical exemptions are designed for individuals that cannot be administered vaccines for medical reasons including individuals who are allergic to the vaccine, the immunosuppressed, and infants under twelve months old. The most common allergic reaction to the MMR vaccine is an allergy to the antibiotic neomycin, which is a component of the vaccine. The immunosuppressed cannot receive the vaccination as a function of how vaccines work; injecting an attenuated version of the virus into the bloodstream tricks the mind into creating an immune response to invaders of that type that becomes stored in the memory. However, for an immunosuppressed individual, this can become extremely risky because the immune system and ability to create antibodies to the viral antigens is impaired to a varying degree of severity. Infants under twelve months old cannot be given the MMR vaccination because at this age, infants still have some of the antibodies from their mother circulating in their bloodstream, which impairs the specificity of the infant’s immune system response to the foreign viral agent.

Religious exemptions from immunization requirements are granted in all but two states currently – held up by the first amendment rights of free exercise of religious beliefs. Click here for an elaboration of these religiously-based oppositions to vaccines.

Personal belief or Philosophical exemptions, also called conscientious belief exemptions are very difficult to obtain. An individual must demonstrate that vaccination conflicts with sincerely held personal beliefs in order to file for this exemption. The individual must be old enough to consent, which is over age 12, and oppose all vaccinations and not just certain vaccines.

Closing the Loopholes: California Proposition SB277

As it stands in California currently, legal access to both medical and religious exemptions are allowed, designed as a way out of vaccination for those individuals that cannot get the vaccine, for obvious medical reasons, and those that feel strongly that their personally held religious tenets oppose immunization. The problem is that the growing strength of anti-vaccination of religious groups on the one hand, but also these strange pockets of affluent communities that are resisting vaccination under the guise of religious claims – for reasons still unclear – create clusters of under-immunized populations, some of which have exemption rates as high as 21 percent; these clusters are vulnerable to outbreaks which jeopardize susceptible members of the community – infants, medically exempt, immunosuppressed, and individuals for whom the vaccination didn’t work all the way. The bill written by Sen. Pan and Sen. Allen aims to close up these loopholes for the purpose of protecting the public health, to become effective on January 1, 2016. The bill has been met with great opposition, as well, and we will elaborate on how these pressures have generated amendments to the bill at each step of the process.

Existing California law states that:

Unless an individual has been fully immunized according to state requirements prior to an individual’s first admission to an education institution (including private or public elementary or secondary school, child care center, nursery school, day care home, or day nursery), he or she is not admitted to the academic institution unconditionally.

The above immunization requirement can be waived if the parent or guardian files with the state authority the proper paperwork demonstrating that there are medical circumstances that make the immunization unsafe for the child.

The above immunization requirement can be waived if the parent or guardian or adult person seeking admission to academic institutions files with the state authorities a letter that demonstrates that the immunization is contrary to his or her beliefs.

Allows for children with these exemptions to be suspended from attending the academic institution if there is probable cause that he or she has been exposed to any of the infections listed in the immunization requirements. These include: diphtheria, haemophilus influenzae type b, measles, mumps, pertussis, poliomyelitis, rubella, tetanus, hepatitis b, and chickenpox.

SB277 would generate the following changes to existing law:

Deletion of the use of personal beliefs to file with state authorities for exemptions.

Require school districts to release to parent of students the immunization rates for the specific school that the child is enrolled at, prior to the beginning of each school term.

Costs incurred by individuals that can be proven to be directly caused by state mandate are subject to reimbursement by the state.

The author’s arguments in favor of these changes state that the recent outbreak of measles in California in which the number of cases reported in January 2015 than in any given month in the past two decades, highlights the vulnerability of the public health due to increasing rates of exemptions, with personal belief exemption rates up 337 percent from 2000.

The bill has since been amended at each step of the legislative process, ceding some of its original demands and clarifying language in order to hopefully speed up the bill’s passing. First heard in its original articulation by the Senate Health Committee, the bill was only passed on to the Senate Education Committee after amending:

Homeschools in which all of the students are residents of the household or members of the same family may retain the right to file for personal belief exemptions.

After this first hearing with the Senate Education Committee, the bill was run in the Senate Education Committee a second time with the following amendments:

Allowing homeschools to maintain the right to file for personal belief exemptions even if the members are not of the same single household in order to expand rights for homeschool communities.

Allowing for students enrolled in independent study programs to file personal belief exemptions.

Five days later, on April 27, 2015, SB277 was read before the Senate Judiciary Committee in order to appropriately address whether this mandate limits or denies equal access to education by forcing some students out of public and private schools and into homeschooling. The ACLU specifically became involved to ensure that any actions that could be deemed as an impediment to equal access to education demonstrate that they are “necessary to achieve a compelling state interest.” But after review by the Senate Judiciary Committee, the bill was passed on to the Senate floor for analysis and further modified the bill to expedite the process. In order to bypass review by the Senate Appropriations Committee, the authors struck out the mandate for schools to notify parents of the immunization rates at the child’s school and added a clause that grandfathers in about 13,000 kids to their respective public and private schools – allowing them to still attend even though they did not meet immunization requirements before entering kindergarten provided that they receive the necessary vaccinations before entering seventh grade.

While these modifications in order to avoid financial clearance have opponents of the bill accusing policy makers of cheating the system, SB 277 went to vote on the Senate floor on May 14, 2015 and was passed with a 25-10 vote in the California State Senate. The next step for this bill in progress is to return to Senate Assembly. For the most recent version of the bill, in addition to full explanations of its amendment history, click here.

Debate at the Capitol: Support and Opposition for SB277

What’s at Stake: The Tradeoff Between Public Health and Individual Freedoms

The controversy over protection of public health versus the protection of individual rights surrounds the idea of the “policing power” of the government. In order for the state to be given policing power over its citizens to forbid or mandate a certain behavior or activity, it has to demonstrate that the good produced for the public by granting the state policing power must be worth suspending individual rights. Especially in the United States where our very independence movement and creation of the Constitution was against a government that did not give the American citizens the right to exercise free decision-making and where individualism is placed as the ideal virtue of the model citizen, individual rights are placed in such high regard that any restrictions on individual rights must have a very convincing rationale in favor of the greater good. In relation to the compulsory vaccination controversy, on the one hand, there is significant benefit to the public to have all people who are able to be immunized required to get their vaccines. It avoids contraction of the disease by the person himself and prevents the spread of disease to other individuals, ensuring both personal and community safety. But on the other hand, there are religious beliefs, confidentiality, issues of consent, access to education, and other factors determined by personal, individual freedom of choice that have a right to be protected.

There is a large quantity of people who believe that this bill violates their individual freedom without proper evidence to show that this violation is necessary. Proponents of the bill argue that the benefit to society of having all citizens vaccinated who are able, justify suspending individual freedom over personal healthcare choices for parents and their children. The first amendment confers upon all citizens the right to free exercise of their beliefs – provided that in doing so, these practices do not cause harm to other citizens. In many cases, historically, these first amendment rights have been suspended in order to achieve some greater good for the public and society as a whole – but as essential and fundamental rights, the right to free exercise does deserve protection.

Thus, in the case of compulsory vaccination, the real issue for supporters of the bill is that opposition to mandated vaccines must be convinced that it is in the best interest of the public and of themselves as members and recipients of public benefits that this mandate is passed. They must be convinced that the severity of the disease if it were to strike in communities and the benefit to the welfare of the public – economically and medically – by avoiding outbreaks and transmission through vaccination programs is serious enough to warrant a suspension of these individual rights which the American public so tightly – and with good reason – holds onto.

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